Comparison of Clinical and Neuroimaging Features between Acute Ischemic Stroke Patients with and without Cancer

  • GUO Lin-jia ,
  • YU Feng ,
  • CHEN Jing ,
  • YIN Yu-hui ,
  • HOU Shu
Expand
  • Department of Neurology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 10038, China

Received date: 2017-12-08

  Revised date: 2018-05-22

  Online published: 2018-12-26

Abstract

Objective To compare the differences of clinical and neuroimaging features between ischemic stroke patients with and without cancer. Methods From January 2013 and July 2017, 41 patients with active cancer diagnosed as acute ischemic stroke were retrospectively analyzed as research group. Besides, 41 age-and sex-matched patients diagnosed as acute ischemic stroke without cancer were selected as control group. The clinical date of both groups were collected and analyzed statistically. Results The percentages of hypertension, hyperlipidemia and past stroke were lower (χ2 > 5.549, P < 0.05), and the percentage of patients with cryptogenic stroke was higher in the research group than in the control group (χ2 > 17.537, P < 0.05). The hemoglobin level was lower (t = 4.609, P < 0.001), the D-dimer level was higher (t = -5.796, P < 0.001) in the research group than in the control group. Multiple vascular lesions of 53.7% patients in the research group were higher than 4.9% in the control group. The percentage of DWI lesions involving three vessel territories was higher in the research group than in the control group (χ2 > 17.995, P < 0.01). The percentage of multiple small lesions, and lesions located in cortical/subcortical lesions or cerebellum was higher in the research group than in the control group (χ2 > 8.159, P < 0.01). The 30 days mRS score after ischemic stroke (t = -3.222, P < 0.01) and the mortality rate within 30 days (P < 0.05) were higher in the research group than in the control group. Conclusion Compared with ischemic stroke patients without cancer, there were more cryptogenic stroke, higher D-dimer levels and poor prognosis in patients with active cancer. In ischemic stroke, patients with active cancer has a unique focal distributions characterized by more multiple vascular lesions involving three vessel territories and more lesions located in cortical/subcortical and cerebellum. The patients with ischemic stroke who conform to above characteristic should be paied attention to tumor screening.

Cite this article

GUO Lin-jia , YU Feng , CHEN Jing , YIN Yu-hui , HOU Shu . Comparison of Clinical and Neuroimaging Features between Acute Ischemic Stroke Patients with and without Cancer[J]. Chinese Journal of Rehabilitation Theory and Practice, 2018 , 24(11) : 1338 -1343 . DOI: 10.3969/j.issn.1006-9771.2018.11.016

References

[1] Chen PC, Muo CH, Lee YT, et al.Lung cancer and incidence of stroke: a population-based cohort study[J]. Stroke, 2011, 42(11): 3034-3039.
[2] Alvarez-Perez FJ, Verde I, Uson-Martin M, et al.Frequency and mechanism of ischemic stroke associated with malignancy: a retrospective series[J]. Eur Neurol, 2012, 68(4): 209-213.
[3] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志, 2015, 48(4): 246-257.
[4] Adams HJ, Bendixen BH, Kappelle LJ, et al.Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment[J]. Stroke, 1993, 24(1): 35-41.
[5] Kwon HM, Kang BS, Yoon BW.Stroke as the first manifestation of concealed cancer[J]. J Neurol Sci, 2007, 258(1-2): 80-83.
[6] Kim SG, Hong JM, Kim HY, et al.Ischemic stroke in cancer patients with and without conventional mechanisms: a multicenter study in Korea[J]. Stroke, 2010, 41(4): 798-801.
[7] Schwarzbach CJ, Schaefer A, Ebert A, et al.Stroke and cancer: the importance of cancer-associated hypercoagulation as a possible stroke etiology[J]. Stroke, 2012, 43(11): 3029-3034.
[8] Navi BB, Singer S, Merkler AE, et al.Cryptogenic subtype predicts reduced survival among cancer patients with ischemic stroke[J]. Stroke, 2014, 45(8): 2292-2297.
[9] Huang YS, Lee CC, Chang TS, et al.Increased risk of stroke in young head and neck cancer patients treated with radiotherapy or chemotherapy[J]. Oral Oncol, 2011, 47(11): 1092-1097.
[10] Guo YJ, Chang MH, Chen PL, et al.Predictive value of plasma (D)-dimer levels for cancer-related stroke: a 3-year retrospective study[J]. J Stroke Cerebrovasc Dis, 2014, 23(4): e249-e254.
[11] Kim JM, Jung KH, Park KH, et al.Clinical manifestation of cancer related stroke: retrospective case-control study[J]. J Neurooncol, 2013, 111(3): 295-301.
[12] Zoller B, Ji J, Sundquist J, et al.Risk of haemorrhagic and ischaemic stroke in patients with cancer: a nationwide follow-up study from Sweden[J]. Eur J Cancer, 2012, 48(12): 1875-1883.
[13] Borowski A, Ghodsizad A, Gams E.Stroke as a first manifestation of ovarian cancer[J]. J Neurooncol, 2005, 71(3): 267-269.
[14] 孙葳,邢海英,彭清,等. 以急性多发性脑梗死为首发表现的隐匿性躯体恶性肿瘤12例报告[J]. 中国神经精神疾病杂志, 2016, 42(7): 385-389.
[15] 张艳召,汪凯,张辉,等. 以急性脑梗死为首发表现的隐匿性恶性肿瘤患者13例临床特点总结[J]. 国际神经病学神经外科学杂志, 2017, 44(1): 58-62.
[16] Zi WJ, Shuai J.Plasma D-dimer levels are associated with stroke subtypes and infarction volume in patients with acute ischemic stroke[J]. PLoS One, 2014, 9(1): e86465.
[17] Cestari DM, Weine DM, Panageas KS, et al.Stroke in patients with cancer: incidence and etiology[J]. Neurology ,2004, 62(11): 2025-2030.
[18] Seok JM, Kim SG, Kim JW, et al.Coagulopathy and embolic signal in cancer patients with ischemic stroke[J]. Ann Neurol, 2010, 68(2): 213-219.
[19] Finelli PF, Nouh A.Three-territory DWI acute infarcts: diagnostic value in cancer-associated hypercoagulation stroke (Trousseau syndrome)[J]. Am J Neuroradiol, 2016, 37(11):2033-2036.
[20] Lee MJ, Chung J, Ahn M, et al.Hypercoagulability and mortality of patients with stroke and active cancer: The OASIS-CANCER study[J]. J Stroke, 2017, 19(1): 77-87.
[21] Nam K, Kim CK, Kim TJ, et al.Intravenous thrombolysis in acute ischemic stroke with active cancer[J]. Biomed Res Int, 2017, 2017: 1-5.
Outlines

/